The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

REDUCING VENTILATOR ASSOCIATED RESPIRATORY INFECTIONS BY DISCONTINUING THE USE OF NORMAL SALINE DURING SUCTIONING IN THE NICU

Rick L. Amato, Pattie G. Bondurant, Deborah A. Hershberger; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Introduction: We are a 59 bed, Level IIIC NICU with a patient population consisting of medical and surgical patients. In our quest to eliminate Ventilator Associated Pneumonia (VAP), we found that there was an increase in Ventilator Associated Respiratory Infections (VARI) that did not meet the criteria for VAP. Our goal to eliminate all ventilator associated infections, we developed a VAP bundle that brought our VAP rate down from 12.8 infections per 1000 ventilator days to 0.5 infections per 1000 ventilator days. One of the things we looked at was whether reducing the use of normal saline during routine suctioning would reduce our VARI rate. Methodology: We surveyed the nursing and respiratory therapy staff to gather information on their use of normal saline during routine suctioning. The survey revealed that 91% of bedside care givers routinely used normal saline to loosen secretions prior to suctioning. Their feelings were that the normal saline would thin out the secretions and thus enabling them to remove the most secretions per pass of the suction catheter. After an extensive literature search we found that there was very little published regarding the neonatal population. We found no evidence that the use of saline was helpful in thinning secretions but the use of saline could result in increased risk for infection. We started an education campaign for all care givers in the NICU on the effects of using normal saline during suctioning. Education centered on that normal saline would not thin out secretions and that normal saline could wash bacteria from the endotracheal tube into the lungs setting up an increase chance of infection. After completing the staff education, we re-surveyed the NICU staff on their use of normal saline during suctioning and found that 73% of the NICU staff indicated that they changed their practice regarding the use of normal saline during suctioning based on the evidence presented during the education. Results: Our VARI rate prior to discontinuing the use of normal saline during routine suctioning was 12 infections per 1000 ventilator days. After discontinuing the use of normal saline for 18 months, our VARI rates dropped to 3 infections per 1000 ventilator days and we have maintained that rate since December 2008. Conclusion: Discontinuing the use of normal saline during routine suctioning has had a positive out come in the reduction of ventilator associated respiratory infections in the NICU, Sponsored Research - None

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